The Integrated HIV Effect Mitigation and Positive Action for Community Transformation (IMPACT) project is expected to improve the wellbeing of 58,017 OVC and 41,505 people living with HIV (PLHIV) in nine districts in central and southern Malawi. Catholic Relief Services brings private sector, information technology and faith-based partners to the Title II-supported Wellness and Agriculture for Life Advancement (WALA) consortium. This alliance mobilizes expertise, cash and in-kind resources to expand access to care and treatment services OVC and PLHIV. IMPACTs implements through existing structures thus enhancing sustainability, country ownership, and active participation of beneficiaries. GOM's heavy involvement in the program at all levels has provided an optimal environment for implementation and coordination of services with various departments and other programs.

In FY12, IMPACT will target 31,000 OVC and 20,000 PLHIV with services largely provided through community-based mechanisms. A small fraction will be supported through facility-based programs in collaboration with MoH. IMPACT has established a robust monitoring and evaluation system that includes use of unique identifiers to track beneficiary and program performance. The management information system (MIS) used to capture and report service data is expected to significantly improve data quality and reporting. 27 motorcycles have been purchased on behalf of 10 consortium partners. Motorcycles are used by supervisors supporting an area equivalent to a traditional authority, as well as district coordinators assisting support groups for people living with HIV. IMPACT anticipates purchasing 2 additional motorcycles to continue support to support groups and to equip supervisors for all operational areas.

IMPACT will collaborate with the MOH, PEPFAR partners (Dignitas and BRIDGE II), and other stakeholders to implement various community-based activities aimed at enhancing access to care and treatment for at least 20,000 PLHIV in nine districts. IMPACT will support the MoH to expand pre-ART services and the retention of PLHIV in longitudinal care and the implementation of a newly developed referral mechanism expected to enhance early diagnosis, access to and retention of clients in care. The referral mechanism was developed by the National HIV task force under the leadership of IMPACT and MOH, and will be piloted, finalized and rolled out nationally in FY12. To increase early diagnosis of HIV, IMPACT will work with MOH and other stakeholders to conduct community health days, during which health services including HIV testing will be conducted. Both adults and children who test positive during these events will be linked to health services through the referral mechanism described above. Mother Infant Pairs (MIPs) will be referred to ensure they receive appropriate care and will be followed up by community health volunteers. To reduce the loss of follow up of clients, IMPACT plans to train and deploy at least 160 expert clients at selected MOH health facilities to work with both facility-based and community-based care providers to address health care needs of clients. An additional 350 community health volunteers, including Health Surveillance Assistants (HSAs), will be oriented on pre-ART, ART, and PMTCT concepts to support identification of clients in need of health services and their retention in care. IMPACT will establish and strengthen 225 support groups whose members will be trained to mobilize local communities to access HIV testing and counseling (HTC) services and promote treatment adherence. This cadre of community health workers is a key link between health facilities and the community. In support of the national PMTCT strategy, IMPACT will orient staff and volunteers on key PMTCT concepts and promote prevention activities. All activities will be monitored and reported using the Management Information System (MIS).

IMPACT will support at least 31,000 OVC through enhanced access and participation in a variety of care and support services, including nutrition, education, economic strengthening, legal and social protection, emotional and psychosocial support, among others, in Balaka, Chikwawa, Chiradzulu, Lilongwe, Machinga, Mulanje, Ntcheu, Thyolo and Zomba. These will be implemented by nine IMPACT partners, in collaboration with government ministries and existing HIV/AIDS programs implemented by other PEPFAR partners (Dignitas and BRIDGE II) and donors (CHAI).

To improve the wellbeing of OVCs in targeted communities, IMPACT will implement four major interventions. The care group model, a globally recognized approach for enhancing health, food security and nutritional status in poor communities, will be applied in all sites by trained care group leaders. At least 15,000, including 5,000 new households, will be targeted with specific skills to promote positive health behaviors. In addition, complementary feeding and learning sessions focusing on food preparation and availability will be conducted twice in each community. The innovative community-integrated management of childhood illnesses approach will be implemented in collaboration with the MOH to increase access to 60 community-based health services. To protect children from abuse and exploitation, IMPACT will support birth registration for at least 20,000 OVC and strengthen capacity of over 3,200 OVC committee members to effectively handle cases of abuse and exploitation. In recognition of the serious challenges faced by OVC in education, IMPACT, in partnership with the Ministry of Education and other education stakeholders, will sponsor at least 900 secondary students. Tutoring and other academic support will be offered to at least 1,200 academically weak primary and secondary students at 30 drop-in centers supported by the program. Performance improvement plans will be developed for each academically weak child and monitored closely by school teachers, drop-in center mentors and family care volunteers (FCV) to improve student performance. Saving accounts and VSL will be promoted.

One of IMPACTs key intermediate results is the reduction of loss-to-follow-up of PLHIV on ART and PMTCT. To date, IMPACT has contributed to the development and piloting of the HIV referral network, in consultation with the GOM and other key stakeholders, through a GOM-led task force that was given the mandate to conduct a situational analysis of current HIV referral mechanisms, as well as work with expert clients. The task force presented the findings to the joint technical working group (TWG) in July 2011, and IMPACT was granted permission to proceed with piloting the integrated referral model, which uses a closed feedback loop, and to work with expert clients. The pilot will continue mid-way through FY12, at which point experiences will be shared via the TWG and consultative meeting with stakeholders. Over 274 expert clients were trained during FY11 and will begin placements early in FY12, pending approval from the Ministry of Health of the service agreement. By working through both community and facility platforms, IMPACT will continue to mobilize and create demand for couples counseling and male involvement in order to increase PMTCT uptake.